front 1 What does GERD stand for | back 1 Gastroesophageal reflux disease |
front 2 Parietal cells in the epithelial lining of the stomach secrete | back 2 hydrochloric acid (HCl) through the H+/K+ -adenosine triphosphatase (ATPase) pump known as the proton pump |
front 3 The pump, and secretion of HCl, is stimulated by histamine, ACh and the hormone gastrin which has the added role of | back 3 stimulating stomach muscle contracentrations to aid in digestion |
front 4 How is acidic gastric contents normally prevented from backflow into the esophagus | back 4 by a protective ring of muscle fibers called lower esophageal sphincter (LES) |
front 5 Patients with GERD have reduced | back 5 LES pressure (muscle tone), and gastric contents can backflow into the esophagus |
front 6 GERD symptoms | back 6 heartburn (daytime or nocturnal), hypersalivation and regurgitation of acidic contents into the mouth or throat |
front 7 How is GERD diagnosed | back 7 based on patient-reported symptoms: duration, daytime and/or nocturnal occurrence, frequency ≥ 2 times/week and risk factors (family history, diet and eating habits) |
front 8 Drugs that can worse GERD | back 8 aspirin/NSAID, bisphosphonates, dabigatran, estrogen products, fish oil products, iron supplements, nicotine replacement therapy, steroids, tetracyclines |
front 9 Patients should be referred for further evaluation if | back 9 they do not respond to lifestyle modifications and/or 2 weeks of OTC self treatment |
front 10 For frequent (≥ 2 times/week) or severe GERD, what is the initial treatment | back 10 8 week course of a PPI |
front 11 Maintenance treatment of GERD | back 11 PPI at the lowest effective dose (alternative: H2RA, if there is no erosive esophagitis) |
front 12 MOA of antacids | back 12 works by neutralizing gastric acid (producing salt and water) which increases gastric pH |
front 13 Since antacids do not require systemic absorption, they provide relief within | back 13 minutes but the duration of relief is short (30- 60 mins) |
front 14 Brand name of calcium carbonate | back 14 Tums |
front 15 Brand name of calcium carbonate + magnesium | back 15 Mylanta Supreme |
front 16 Brand name of calcium carbonate + simethicone | back 16 Maalox Advanced Maximum Strength |
front 17 Brand name of magnesium hydroxide | back 17 Milk of Magnesium |
front 18 Brand name of magnesium hydroxide + aluminum + simethicone | back 18 Mylanta Maximum Supreme |
front 19 Brand name of sodium bicarbonate/aspirin/citric acid | back 19 Alka-Seltzer |
front 20 Aluminum and magnesium can | back 20 accumulate with severe renal dysfunction (not recommended if CrCl < 30 mL/min) |
front 21 Side effects of calcium | back 21 constipation, bloating, bleching |
front 22 Side effects of aluminum | back 22 constipation, hypophosphatemia |
front 23 Side effects of magnesium | back 23 loose stools |
front 24 MOA of H2RA | back 24 reversibly inhibit H2 receptors on gastric parietal cells which decrease gastric acid secretion |
front 25 Brand name for famotidine | back 25 Pepcid AC |
front 26 Brand name for cimetidine | back 26 Tagamet HB |
front 27 Onset of relief for H2RA | back 27 within 60 mins, duration 4-10 hours |
front 28 Which H2RA was removed from the market in 2020 | back 28 ranitidine (Zantac) |
front 29 MOA of PPIs | back 29 irreversibly bind to the gastric H+/K+ ATPase pump in parietal cells (this shuts down the pump and blocks gastric acid secretion) |
front 30 Which PPIs do you take before breakfast | back 30 esomeprazole, lansoprazole, omeprazole |
front 31 Brand name for esomeprazole | back 31 Nexium |
front 32 Brand name for lansoprazole | back 32 Prevacid |
front 33 Brand name for omeprazole | back 33 Prilosec |
front 34 Brand name for dexlansoprazole | back 34 Dexilant |
front 35 Brand name for pantoprazole | back 35 Protonix |
front 36 Brand name for rabeprazole | back 36 Aciphex |
front 37 PPIs may diminish the therapeutic effect of which medication | back 37 clopidogrel |
front 38 Side effects of IV Protonix | back 38 thrombophlebitis, severe skin reactions (SJS/TEN) |
front 39 Onset of PPIs | back 39 1-3 hours, duration > 24 hours |
front 40 Which PPIs are available IV | back 40 pantoprazole and esomeprazole |
front 41 Which PPIs capsules can be opened, mixed in applesauce and swallowed immediately | back 41 dexlansoprazole, esomeprazole, lansoprazole, omeprazole and rabeprazole (everyone but pantoprazole) |
front 42 What vitamin deficiency can occur with long-term PPI use | back 42 vitamin B12 |
front 43 Which PPIs come in ODT formulation | back 43 lansoprazole, omeprazole |
front 44 Which H2RA comes in an injection | back 44 famotidine |
front 45 MOA of metoclopramide | back 45 dopamine antagonist |
front 46 PPIs inhibit what enzyme | back 46 CYP2C19 |
front 47 PPIs can increase the levels of | back 47 citalopram, phenytoin, tacrolimus, voriconazole and warfarin |
front 48 How does peptic ulcer disease (PUD) occur | back 48 occurs when there is mucosal erosion within the GI tract |
front 49 Where does peptic ulcer usually occur | back 49 in the duodenum (small percentage occur in the stomach) |
front 50 Three most common causes of PUD | back 50 H. pylori, NSAIDs and stress ulcer |
front 51 What is H. pylori | back 51 a spiral-shaped, pH-sensitive, gram-negative bacterium that lives in the acidic environment of the stomach |
front 52 Primary symptom of PUD | back 52 dyspepsia, a gastric pain that can feel like a gnawing or burning sensation in the middle or upper stomach |
front 53 If the ulcer is in the duodenal, what are the symptoms | back 53 pain is typically worse 2-3 hours after eating, eating food or taking antacids lessens the pain |
front 54 With gastric ulcers, what are the symptoms | back 54 eating generally worsens the pain |
front 55 Diagnostic test for H. pylori | back 55 urea breath test (UBT) |
front 56 First line treatment for H.pylori | back 56 quadruple therapy |
front 57 When is triple therapy treatment for H.pylori considered first-line | back 57 only if clarithromycin resistance rates are low (<15%) and the patient has no previous history of taking a macrolide antibiotic for any reason |
front 58 What medications are in the quadruple therapy treatment | back 58 bismuth subsalicylate 300 mg QID + metronidazole 250-550 mg QID + tetracycline 500 mg QID + PPI BID (take for 10-14 days) |
front 59 What drugs does Pylera contain | back 59 bismuth subcitrate potassium 420 mg + metronidazole 375 mg + tetracycline 375 mg |
front 60 What drugs are in concomitant therapy for H.pylori | back 60 amoxicillin 1000 mg BID + clarithromycin 500 mg BID + metronidazole 500 mg BID + PPI BID (take for 10-14 days) |
front 61 What drugs are in clarithromycin triple therapy | back 61 amoxicillin 1000 mg BID + clarithromycin 500 mg BID + PPI BID (take for 14 days) |
front 62 What drugs are in Prevpac | back 62 amoxicillin + clarithromycin + lansoprazole |
front 63 How does NSAIDs cause ulcers | back 63 direct irritation of the gastric epithelium and systemic inhibition of prostaglandin synthesis |
front 64 Risk factors for NSAID induced ulcers | back 64 age > 60 y/o, history of PUD, high-dose NSAID, using > 1 NSAID, concomitant use of anticoagulants, steroids, SSRIs or SNRIs |
front 65 Brand name of naproxen/esomeprazole | back 65 Vimovo |
front 66 Brand name of ibuprofen/famotidine | back 66 Duexis |
front 67 Brand name of diclofenac/misoprostol | back 67 Arthrotec |
front 68 Brand name of misoprostol | back 68 Cytotec |
front 69 MOA of misoprostol | back 69 prostaglandin E1 analog that replaces the gastro-protective prostaglandins removed by NSAIDs |
front 70 MOA of sucralfate | back 70 sucrose-sulfate-aluminum complex and can interact with albumin and fibrinogen to form a physical barrier over an ulcer |
front 71 Brand name of sucralfate | back 71 Carafate |
front 72 Side effects of misoprostol | back 72 diarrhea, abdominal pain |
front 73 Side effects of sucralfate | back 73 constipation |